Tranzo, Tilburg School of Social and Behavioral Sciences, Tilburg University, Postbus 90153, 5000 LE, Tilburg, Netherlands.
NIVEL, Otterstraat 118-124, 3513 CR, Utrecht, Netherlands.
BMC Fam Pract. 2021 Sep 21;22(1):190. doi: 10.1186/s12875-021-01540-7.
General practitioners (GPs) can be considered the designated professionals to identify high fall risk and to guide older people to fall preventive care. Currently it is not exactly known how GPs treat this risk. This study aims to investigate GPs' daily practice regarding fall preventive care for frail older patients.
Sixty-five GPs from 32 Dutch practices participated in this study for a period of 12 months. When a GP entered specific International Classification of Primary Care-codes related to frailty and/or high fall risk in their Electronic Health Records, a pop-up appeared asking "Is this patient frail?". If the GP confirmed this, the GP completed a short questionnaire about patient's fall history and fear of falling (FOF), and the fall preventive care provided.
The GPs completed questionnaires regarding 1394 frail older patients aged ≥75. Of 20% of these patients, the GPs did not know whether they had experienced a fall or not. The GPs did not know whether a FOF existed in even more patients (29%). Of the patients with a fall history and/or a FOF (N = 726), 37% (N = 271) received fall preventive care. Two main reasons for not offering fall preventive care to these patients were: I) the patient finds treatment too intensive or too much of a hassle (37%), and II) the GP identified a high fall risk but the patient did not acknowledge this (14%). When patients were treated for high fall risk, the GP and the physiotherapist were the most frequently involved health care providers. The involved health care providers most often treated mobility limitations, cardiovascular risk factors, and FOF.
The results from this study show that GPs were frequently not aware of their frail patient's fall history and/or FOF and that the majority of the frail older patients with a fall history and/or FOF did not receive fall preventive care. Developing systematic screening strategies for the primary care setting enhancing the identification of high fall risk and the provision of fall preventive care may improve patients' quality of life and reduce health care costs.
全科医生（GP）可以被认为是识别高跌倒风险和指导老年人进行跌倒预防保健的指定专业人员。目前尚不清楚 GP 如何处理这种风险。本研究旨在调查 GP 对虚弱老年人跌倒预防保健的日常实践。
32 家荷兰诊所的 65 名 GP 参与了这项为期 12 个月的研究。当 GP 在其电子健康记录中输入与虚弱和/或高跌倒风险相关的特定国际初级保健分类代码时，会弹出一个窗口，询问“这位患者是否虚弱？”如果 GP 确认这一点，GP 会填写一份简短的问卷，内容涉及患者的跌倒史和对跌倒的恐惧（FOF），以及提供的跌倒预防保健措施。
GP 们填写了 1394 名≥75 岁虚弱老年患者的问卷。在这些患者中，有 20%的患者的 GP 不知道他们是否经历过跌倒。更多的患者（29%）的 GP 甚至不知道他们是否存在 FOF。在有跌倒史和/或 FOF 的患者中（N=726），有 37%（N=271）接受了跌倒预防保健。不给这些患者提供跌倒预防保健的两个主要原因是：I）患者认为治疗过于密集或过于麻烦（37%），以及 II）GP 识别出高跌倒风险，但患者不承认（14%）。当患者接受高跌倒风险治疗时，GP 和物理治疗师是最常涉及的医疗保健提供者。涉及的医疗保健提供者最常治疗活动受限、心血管风险因素和 FOF。
本研究结果表明，GP 经常不知道他们虚弱患者的跌倒史和/或 FOF，并且大多数有跌倒史和/或 FOF 的虚弱老年患者没有接受跌倒预防保健。在初级保健环境中开发系统的筛查策略，增强对高跌倒风险的识别和提供跌倒预防保健措施，可能会提高患者的生活质量并降低医疗保健成本。
